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NCLEX Review About The Aging Eye

Situation: Mang Tomas is a 60 year old man who has just had cataract surgery performed on his right eye.

1. The physician has prescribed Cyclogel preoperatively to:

a) prevent dryness of the cornea and conjunctiva


b) reduce the inflammation of the iris and choroids
c) paralyze the ciliary muscle
d) promote drainage of aqueous humor from the chamber of the eye

2. After discharge, Mang Tomas attends the eye clinic for follow-up visits. When he receives his cataract
glasses, it is important that the nurse advise him that:

a) his peripheral vision will be increased


b) objects will appear closer than they really are
c) magnification by the lens is only about 10%
d) daily eye drops are required with these lenses

3. The nurse should instruct a client preparing for eye surgery that which of these activities will be restricted
post-operatively?

a) bending with the knees flexed


b) bending from the waist
c) keeping the head in a neutral position
d) lying flat

4. Nursing care for Mang Tomas during the first 48 hours after surgery will include:

a) maintain bed rest


b) changing the dressing daily
c) encouraging coughing and deep breathing
d) lie on the unoperated side

Situation: Mang Ben is diagnosed with glaucoma and is scheduled for surgery.

5. Which symptoms are associated with acute closed-angle glaucoma?

a) diplopia and photophobia


b) episodic blindness and no pain
c) blurred vision and colored rings around lights
d) sensation of curtain drawn across the visual field

6. Which order for Mang Ben before surgery will the nurse question:

a) demerol (meperidine) 50 mg IM
b) atropine sulfate 0.4 mg IM
c) valium (diazepam) 2 mg IM
d) phenergan (promethazine) 25 mg IM

7. A physician prescribes "patching" for a child with strabismus of the right eye. A nurse instructs the mother
regarding this procedure. Which of the following statements when made by the mother indicates that she
understands the instruction?

a) I will place the patch on the right eye


b) I will place the patch on both eyes
c) I will place the patch on the left eye
d) I will alternate the patch from right to left eye hourly

8. The client comments, "I frequently change my eye glasses, none of which is satisfactory and I have
difficulty focusing on my work." Which of the following disorders may the client be experiencing?

a) cataract
b) glaucoma
c) detached retina
d) myopia

9. An 85-year old woman complains of pain in her operated eye after cataract removal surgery. The nurse
knows that this symptoms is

a) expected, and she should offer analgesic


b) unexpected and may signify a detached retina
c) unexpected and may indicate hemorrhage
d) expected and she should advise the client to be on bed rest

10. The client had just undergone repair of detached retina. Which of the following should be included in the
nursingcare plan of the client?

a) encourage self-care activities


b) limit movement of his eyes
c) restrict excessive talking
d) limit fluid intake

11. Which of the following is an effective technique of communicating with a hearing impaired client?

a) speak slowly in a low tone of voice


b) speak slowly in a loud voice
c) speak slowly and try to overemphasize words
d) speak slowly and directly in front of the client

12. Which of the following client statements indicates the need to postpone cataract surgery in the morning?

a) this seasonal allergy should no be a problem


b) the medications instilled into my eyes make my vision blurred
c) I feel nervous with my operation tomorrow
d) I have allergy to certain medications

13. Which of the following is done when performing Weber test?

a) place vibrating tuning fork in front of the opening of the ear


b) place the vibrating tuning fork in the middle of the head
c) place the vibrating tuning fork behind the ear
d) irrigate the ear with cold water and observe movement of the eyes

14. The client has been diagnosed to have Meniere's disease. Which of the following should be included
when giving health teachings?

a) limit carbohydrates and proteins in the diet


b) limit salt intake
c) limit fats in the diet
d) drink a lot of fluids

15. The nurse plans care for a client with acute glaucoma who reports severe pain in the eyes and rainbow
colors (halos) around lights. Which action should the nurse take first?

a) administer pain medication


b) explain to the client that with reduction in intraocular pressure, pain and other symptoms will subside
c) provide preoperative teachings to the client
d) assess the client's visual status

16. A nurse is providing instructions to a client and the family regarding home care after right eye cataract
removal. Which statement by the client would indicate an understanding of the instructions?

a) I will not sleep on my left side


b) I will not sleep on my right side
c) I will not sleep with my head elevated
d) I will not wear my glasses until my physician says it is okay

17. A day care nurse is observing a 2-year old child and suspects that the child may have strabismus. Which
observation made by the nurse might indicate this condition?

a) the child has difficulty


b) the child consistently tills the head to see
c) the child consistently turns the head to see
d) the child does not respond when spoken to

18. The mother of a 6-year old child arrives at a clinic because the child has been experiencing scratchy, red,
and swollen eyes. The nurse notes a discharge from the eyes and sends a culture to the laboratory for
analysis. Chlamydial conjunctivitis is diagnosed. Based on this diagnosis, the nurse determines that which of
the following requires further investigation?

a) possible trauma
b) possible sexual abuse
c) presence of an allergy
d) presence of a respiratory infection

19. A nurse prepares a teaching plan for a mother of a child diagnosed with bacterial conjunctivitis. Which of
the following, if stated by the mother, indicates a need for further teaching?

a) I need to wash my hands frequently


b) I need to clean the eye as prescribed
c) it is okay to share towels and washcloths
d) I need to give the eye drops as prescribed

20. A nurse provides discharge instructions to the mother of a child after myringotomy with insertion of
tympanostomy tubes. The nurse determines that the mother needs additional instructions if the mother
states that:

a) swimming in deep water is prohibited


b) swimming in lake water needs to be avoided
c) she will place earplugs in the child's ears during baths and showers
d) she will be sure to give her child soft tissues to blow his nose

21. Shortly after a neonate is delivered, erythromycin is instilled into the neonate’s eyes. This drug is given
to prevent:

a. Ophthalmia neonatorum
b. Retrolental fibroplasias
c. Corneal keratitis
d. Acute uveitis

22. An older female client confides to the visiting nurse that she is afraid she will fall while going to the
bathroom at night. Which suggestion, if made by the nurse, indicates that the nurse understands
the visual changes affecting the older client?

a) limit your fluid intake during the day


b) use a commode in your bedroom at night
c) keep a red light on the bathroom at night
d) us ea bell to call your daughter if you need to get up

23. The nurse is developing a plan of care for the client scheduled for cataract surgery. The nurse
documents which most appropriate nursing diagnosis in the plan of care?

a) anxiety
b) self-care deficit
c) nutrition, imbalanced
d0 sensory perception, disturbed

24. The nurse is performing an assessment on a client with a suspected diagnosis of cataract. The chief
clinical manifestation that the nurse would expect to note in the early stages of cataract formation is:

a) diplopia
b) eye pain
c) floating spots
d) blurred vision

25. In preparation for cataract surgery, the nurse is to administer prescribed eye drops. The nurse reviews
the physician's orders, expecting which type of eye drops to be prescribed?

a) a miotic agent
b) a thiazide diuretic
c) an osmotic diuretic
d) an mydriatic medication

26. During the early postoperative period, the client who has had a cataract extraction complains of nausea
and severe eye pain over the operative site. The initial nursing action is to:

a) call the physician


b) reassure the client that this is normal
c) turn the client on his or her operative side
d) administer the ordered pain medication and anti-emetic

27. The client is being discharged from the ambulatory care unit following cataract removal. The nurse
provides instructions regarding home care. Which of the following, if stated by the client, indicates an
understanding of the instructions?

a) I will take aspirin if I have any discomfort


b) I will sleep on the side that I was operated on
c) I will not lift anything if weighs more than 10 pounds
d) I will wear my eye shield at night and my glasses during the day

28. The client with glaucoma asks the nurse if complete vision will return. The most appropriate response is:

a) your vision will never return to normal


b) your vision will return soon as the medication begins to work
c) your vision loss is temporary and will return in about 3 to 4 weeks
d) although some vision has been lost and cannot be restored, further loss may be prevented by adhering to
thetreatment plan

29. The nurse is developing a teaching plan for the client with glaucoma. Which of the following instructions
would the nurse include in the plan of care?

a) avoid overuse of the eyes


b) decrease the amount of salt in the diet
c) eye medications will need to be administered for the client's entire life
d) decrease fluid intake to control the intraocular pressure

30. The nurse is preforming an admission assessment on a client with a diagnosis of detached retina. Which
of the following is associated with this eye disorder?

a) total loss of vision'


b) pain in the affected eye
c) a yellow discoloration of hte sclera
d) a sense of a curtain falling across the field of vision

31. The nurse is caring for a client with a diagnosis of detached retina. Which assessment sign would
indicate that bleeding has occurred as a result of the retinal detachment?

a) total loss of vision


b) a reddened conjunctiva
c) a sudden sharp pain in the eye
d) complaints of a burst of black spots or floaters

32. The client arrives in the emergency room following an automobile accident. The client's forehead hit the
steering wheel and a hyphema is diagnosed. The nurse places the client in which position?

a) flat on bed rest


b) semi-fowler's on bed rest
c) lateral on the affected side
d) lateral on the unaffected side

33. The client sustains a contusion of the eyeball following a traumatic injury with a blunt object. Which
intervention is initiated immediately?

a) notify the physician


b) apply ice to the affected eye
c) irrigate the eye with cool water
d) accompany the client to the emergency room

34. The client arrives in the emergency room with a penetrating eye injury from wood chips that occurred
while cuttingwood. The nurse assesses the eye and notes a piece of wood protruding form the eye. What is
the initial nursing action?

a) apply an eye patch


b) perform visual acuity tests
c) irrigate the eye with sterile saline
d) remove the piece of wood using a sterile eye clamp

35. The client arrives in the emergency room after sustaining a chemical eye injury from a splash of battery
acid. The initial nursing action is to:

a) begin visual acuity testing


b) cover the eye with a pressure patch
c) swab the eye with antibiotic ointment
d) irrigate the eye with sterile normal saline

36. The nurse is caring for a client following enucleation. The nurse notes the presence of bright red
drainage on the dressing. Which nursing action is appropriate?

a) notify the physician


b) document the finding
c) continue to monitor the drainage
d) mark the drainage on the dressing and monitor for any increase in bleeding

37. A 55-year old woman was working in her garden. She accidentally sprayed insecticide into her right eye.
She calls the emergency room frantic and screaming for help. The nurse should instruct the woman to take
which immediate action?

a) call the physician


b) irrigate the eyes with water
c) come to the emergency room
d) irrigate the eyes with diluted hydrogen peroxide

38. The clinic nurse is preparing to test the visual acuity of a client using a Snellen chart. Which of the
following identifies the accurate procedure for this visual acuity test?

a) the right eye is tested, followed by the left eye, and then both eyes are tested
b) both eyes are assessed together, followed by the assessment of the right and the left eyes
c) the client is asked to stand at a distance of 40 feet from the chart and asked to read the largest line in the
chart
d) the client is asked to stand at a distance of 40 feet from the chart and read the line that can be read 200
feet away by an individual with unimpaired vision

39. The client's vision is tested with a Snellen chart. The results of the tests are documented as 20/60. The
nurse interprets this as:

a) the client is legally blind


b) the client's vision is normal
c) the client can read at distance of 60 feet what a client with normal vision can read at 20 feet
d) the client can read only at distance of 20 feet what a client with normal vision can read at 60 feet

40. The clinic nurse notes that following several eye examinations, the physician has documented a
diagnosis of legal blindness in the client's chart. The nurse reviews the results of the Snellen chart test
expecting note which finding?

a) 20/20 vision
b) 20/40 vision
c) 20/60 vision
d) 20/200 vision

41. Tonometry is performed on the client with a suspected diagnosis of glaucoma. The nurse analyzes the
test results as documented in the client's chart and understands that the normal intraocular pressure is:

a) 2 to 7 mm Hg
b) 10 to 21 mm Hg
c) 22 to 30 mm Hg
d) 31 to 35 mm Hg

42. The nurse is preparing a teaching plan for a client who is undergoing cataract extraction with intraocular
implantation. Which home care measures will the nurse include in the plan? Select all that apply

a) avoid activities that require bending over


b) contact the surgeon if eye scratchiness occurs
c) place an eye shield on the surgical eye at bedtime
d) episodes of sudden severe pain in the eye are expected
e) contact the surgeon if a decrease in visual acuity occurs
f) take acetaminophen (Tylenol) for minor eye discomfort

43. The client is receiving an eye drop and eye ointment to the right eye. The nurse should:

a) administer the eye drop first, followed by the eye ointment


b) administer the eye ointment first, followed by the eye drop
c) administer the eye drop, wait 10 minutes, and administer the eye ointment
d) administer the eye ointment, wait 10 minutes, and administer the eye drop

44. The nurse is caring for a client with glaucoma. Which of the following medications, if prescribed for the
client, would the nurse question?

a) carbachol (Carboptic)
b) atropine sulfate (Isopto Atropine)
c) pilocarpine (Ocusert Pilo-20, Ocusert Pilo-40)
d) pilocarpine hydrochloride (Isopto Carpine)

45. A miotic medication has been prescribed for the client with glaucoma. The client asks the nurse about
the purpose of the medication. The nurse tells the client that:

a) the medication will help dilate the eye to prevent pressure from occurring
b) the medication will relax the muscles of the eyes and prevent blurred vision
c) the medication causes the pupil to constrict and will lower the pressure in the eye
d) the medication will help block the responses that are sent to the muscles in the eye

46. Pilocarpine hydrochloride (Isopto Carpine) is prescribed for the client with glaucoma. Which of the
following medications does the nurse plan to have available in case of systemic toxicity?

a) atropine sulfate
b) pindolol (Visken)
c) protamine sulfate
d) naloxone hydrochloride (Narcan)

47. Betaxolol hydrochloride (Betoptic) eye drops have been prescribed for the client with glaucoma. Which
of the following nursing actions is most appropriate related to monitoring for the side effects of this
medication?

a) monitoring temperature
b) monitoring blood pressure
c) assessing peripheral pulses
d) assessing blood glucose level

48. In preparation for cataract surgery, the nurse to administer cyclopentolate (Cyclogyl) eye drops. The
nurse a is to administer the eye drops, knowing that the purpose of this medication is to:

a) produce miosis of the operative eye


b) dilate the pupil of the operative eye
c) provide lubrication to the operative eye
d) constrict the pupil of the operative eye

49. The home health nurse visits a client at home and instructs the client on the administration of the
prescribed eye drops. Which of the following statements by the client indicates a need for further education?

a) I can lie down, pull up the upper lid, and place the drop in the lower lid
b) I can lie down, pull down on the lower lid, and place the drop in the lower lid
c) I can sit and tilt my head back, pull down on the lower lid, and place the drop in the lower lid
d) I can lie on my side opposite to the eye I am going to place the drop, put the drop in the corner of the lid
nearest my nose, and then slowly turn to my other side while blinking

50. The nurse is providing instructions to a client who will be self-administering eye drops. To minimize the
systemic effects that eye drops can produce, the nurse instructs the client to:

a) eat before instilling the drops


b) swallow several times after instilling the drops
c) blink vigorously to encourage tearing after instilling the drops
d) occlude the nasolacrimal duct with a finger over the inner canthus for 30 to 60 seconds after instilling the
drops

NCLEX Review About The Aging Eye:


ANSWERS AND RATIONALE

1) C
- another preoperative eye drop that is usually prescribed to patient awaiting cataract surgery is tropicamide
(mydriacyl) which is a dilating agent.

2) B
- cataract surgery is performed to remove the opacified lens. After surgery, a new artificial lens will be
inserted at the posterior chamber or the client will be left without a lens. Aphakia or the absence of lens can
be corrected to restore normal vision by eye glasses, contact lenses or intraocular lenses.
Eye glasses are the safest and least expensive alternative. The nurse should inform the patient that the
eyeglasses will be thick and will cause objects to appear closer than they really are and vertical lines will also
appear curved.
Contact lenses provide better visual correction than eye glasses but the patient must learn how to insert,
clean and replace the lenses correctly. This can be difficult for elderly clients afflicted with arthritis,
Parkinson's disease and Alzheimer's.
Intraocular lenses are implants that provide the best visual correction. However, it is associated with more
postoperative complications.

3) B
- during the postoperative period of eye surgery, activities that increase intraocular pressure should be
avoided:
• instruct patient to avoid bending over
• avoid vomiting - give antiemetics
• avoid coughing - give antitussives, avoid conditions that stimulate coughing
• avoid sneezing - avoid allergens that stimulate sneezing such as powders, dusts etc.
• avoid straining - use stool softener
• avoid lifting heavy objects
4) D
- Cataract is clouding or opacity of the lens which prevents light rays from reaching the retina. Cataract is
not due to trauma tends to occur bilaterally but they do not mature at the same time.

Immature cataracts are not completely opaque and thus allow some light to pass providing the patient
with some useful vision.
Mature cataract occurs when the lenses are completely opaque and vision is greatly reduced or absent.

Intumescent cataract occurs when the lens absorbs water and increases in size resulting in glaucoma.

Hypermature cataract occurs when the lens protein breaks down into short chain polypeptides and leak
through the lens capsules. The proteins are engulfed by macrophages and may lead to phacolytic glaucoma.

The cause are:


• congenital cataract - heredity
• traumatic cataract - exposure heat
• senile cataract - aging, most common cause
• secondary cataract - caused by another disease
It is manifested by:
• blurred vision
• photophobia - client complains to glare
• progressive loss of vision
• opaque or cloudy white pupil
• difficulty to identify colors
• indirect opthalmoscpe - red reflex is distorted or absent
• patient does not experience pain
Instructions after Cataract Surgery include:
• leave ocular dressing/eye patch in place, it is usually removed after 24 hours
• limit activity for 24 hours
• avoid reading
• avoid rubbing eyes
• wear eye glasses for protection during the day
• avoid lifting more than five pounds
• avoid straining and any activity that increase IOP
• lie on unoperated side
• avoid aspirin or any drug containing aspirin
• use eye shield to protect eyes
• pain and itching after surgery is normal and can be relieved with acetaminophen. Report persistent
and unrelieved pain.
• report redness around the eye, nausea and vomiting
• avoid touching and rubbing of eyes
• avoid closing of eyes tightly
After surgery, instruct client to return for follow-up care. If the surgery is out-patient, first clinic visit is after
24 hours, then after one week and then after one month.

5) C
- Glaucoma is due to increased ocular pressure (normal is 10-20 mm/Hg) from accumulation of
aqueous humor in the eye that damages the optic nerve resulting in irreversible blindness. Aqueous humor is
produced by the ciliary body, nourishes the cornea and lens and flows out of the eye through the trabecular
meshwork via the canal of Schlemm.

Two kinds of Glaucoma:

1. Close Angle/Narrow/Acute - caused by narrowing of the anterior chamber or blockage that occurs
between cornea and iris. This type of glaucoma can develop only in one eye and occurs suddenly. It is
common in people of Asian ancestry and associated with aging.
Symptoms include:
• intermittent episodic attacks characterized by severe eye pain, headache, face pain and abrupt
decrease of visual acuity that occur when pupils dilate such as during emotional upset and when
patient is adjusting vision in darkness
• blurred vision to loss of vision
• rainbow halos around lights
• nausea and vomiting
• rapid rise of intraocular pressure
• cloudy cornea
• reddened conjunctiva
2. Open angle/chronic/simple - caused by blockage in the trabecular meshwork and the canal of
Schlemm. this type of glaucoma is usually bilateral, with insidious onset, and often hereditary. it is the most
common type of glaucoma in adults.
Symptoms include:
• appearance early in the disease of scotoma or blind spots
• gradual loss of peripheral vision
• gradual increase of intraocular pressure especially upon awakening and when lying flat
• halos around lights
• mild headaches
• difficulty focusing on near objects and adapting in the dark
• affects both eyes but progression of the disease is not the same
• vague symptoms so that it is often called "thief of the night" glaucoma because patient is unaware
until visual acuity is greatly reduced.
6) B
- drugs which cause pupils to dilate should be avoided by persons having angle closure glaucoma as they
increase flow of fluid, and thus, the intraocular pressure.
This includes:
• atropine
• anticholinergics
• patient should also avoid caffeine
Drugs used in Glaucoma are:

1. Betablockers: Timolol/Betaxolol
• action: decreases production of aqueous humor
• side effects: bradycardia, hypotension
• contraindication: asthma, heart block, COPD
2. Carbonic Anhydrase: Acetazolamide/Mannitol
• action: decreases production of aqueous humor
• side effects: allergy (do not give if with sulfa allergy), weight loss, electrolyte imbalance,
depression, impotence
3. Cholinergics: Pilocarpine/Carbachol
• action: increases outflow of aqueous humor
• side effects: pain, blurry vision, diminished vision at dark
4. Adrenergics: Epinephrine/Dipivefrin
• action: decreases production of aqueous humor
• side effects: tremors, headache, redness and itching

7) C
- In strabismus, patch the good eye. This will train the affected eye.

8) B
- glaucoma is an eye disorder that causes damage to the retina and optic nerve that may lead to blindness.
Eye glasses does not improve the vision, so the client frequently changes them.

9) C
- pressure or pain in the eye postop indicates hemorrhage. This should be reported to the physician.

10) B
- limiting eye movement after retinal surgery is done by application of pressure dressing. This is to prevent
increase in intraocular pressure.

11) D
- speaking slowly allows the client to understand the message. And speaking in fron of the client allows him
to read the lip movement of the speaker. Avoid using loud voice pitch. High-pitched voice is more difficult to
be understood by hearing-impaired client.
12) A
- seasonal allergy is characterized by sneezing and coughing. These may cause increase in intraocular
pressure (IOP) and bleeding after eye surgery.
13) B
- describes weber test, which confirms presence of sensorineural hearing loss like Meniere's disease.

14) B
- meniere's disease is a disorder caused by increased endolymphatic pressure in the inner ear; characterized
by vertigo, tinnitus, gradual hearing loss. Low sodium diet is indicated to prevent further accumulation of
endolymphatic fluids.

15) A
- pain is the priority problem in a client with glaucoma. Loss of vision in glaucoma is irreversible.

16) B
- after cataract surgery, the client should not sleep on the side of the body that was operated on. The client
also should be placed in a semi-fowler's position to assist in minimizing edema and intraocular pressure.
During the day, the client may wear glasses or a protective shield; at night, the protective shield alone is
sufficient.

17) B
- Strabismus is a condition in which the eyes are not aligned because of lack of coordination of
the extraocular muscles. The nurse may suspect strabismus in a child when the child complains of frequent
headaches, squints, or tilts the head to see. Options A, C, and D are not indicative of this condition.

18) B
- Conjunctivitis is an inflammation of the conjunctiva. A diagnosis of chlamydial conjunctivitis in a child who
is not sexually active should signal the health care provider to assess the child for possible sexual abuse.
Allergy, infection, and trauma can cause conjunctivitis, but the causative organism is not likely to be
chlamydia.

19) C
- Conjunctivitis is an inflammation of the conjunctiva. Bacterial conjunctivitis is highly contagious, and the
nurse should teach infection control measures. These include good hand washing and not sharing towels and
washcloths. Options A, B, and D are correct treatment measures.

20) D
- A myringotomy is the insertion of tympanoplasty tubes into the middle ear to equalize pressure and keep
the ear aerated. Parents need to be instructed that the child should not blow his or her nose for 7 to 10 days.
Bath and lake water are potential sources of bacterial contamination. Diving and swimming in deep water
are prohibited. The child’s ears need to be kept dry. Options A, B, and C are appropriate instructions.

21) A
- Erythromycin is an antibiotic used to prevent Ophthalmia neonatorum (ocular gonorrheal infection. It
doesn’t prevent other eye disorders.
22) C
- Because it takes longer to adapt to changes from dark to light and vice versa, older persons are at a
greater risk of falls and injuries. Wherever a sudden change from dark to light or from light to dark occurs
can be dangerous. Getting up during the night is a hazardous situation for an older client. Eyes adapt to the
dark by using the rod receptors, which are sensitive to short blue-green wavelengths. Red wavelengths are
longer and are perceived by the cones. Thus, a red light in the bathroom at night will allow for vision to
function in the dark adequately without the need for adaptation.
23) D
- The most appropriate nursing diagnosis for the client scheduled for cataract surgery is Sensory perception,
disturbed (visual) related to lens extraction and replacement. Although options A, B, and C identify nursing
diagnoses that may be appropriate, they are not related specifically to cataract surgery.
24) D
- A gradual, painless blurring of central vision is the chief clinical manifestation of a cataract. Early symptoms
include slightly blurred vision and a decrease in color perception. Options A, B, and C are not signs of a
cataract.
25) D
- A mydriatic medication produces mydriasis or dilation of the pupil. Mydriatic medications are used
preoperatively in the cataract client. These medications act by dilating the pupils. They also constrict blood
vessels. An osmotic diuretic may be used to decrease intraocular pressure. A miotic medication constricts
the pupil. A thiazide diuretic is not likely to be prescribed for a client with a cataract.
26) A
- Severe pain or pain accompanied by nausea is an indicator of increased intraocular pressure and should be
reported to the physician immediately. Options B, C, and D are inappropriate actions.
27) D
- The client is instructed to wear a metal or plastic shield to protect the eye from accidental injury and is
instructed not to rub the eye. Glasses may be worn during the day. Aspirin or medications containing aspirin
are not to beadministered or taken by the client and the client is instructed to take acetaminophen (Tylenol)
as needed for pain. The client is instructed not to sleep on the side of the body on which the operation
occurred. The client is not to lift more than 5 lb.
28) D
- Vision loss to glaucoma is irreparable. The client should be reassured that although some vision has been
lost and cannot be restored, further loss may be prevented by adhering to the treatment plan. Option A does
not provide reassurance to the client.
29) C
- The administration of eye drops is a critical component of the treatment plan for the client with glaucoma.
The client needs to be instructed that medications will need to be taken for the rest of his or her life. Options
A, B, and D are not accurate instructions.
30) D
A characteristic manifestation of retinal detachment described by the client is the feeling that a shadow or
curtain is falling across the field of vision. No pain is associated with detachment of the retina. Options A and
C are not characteristics of this disorder. A retinal detachment is an ophthalmic emergency and even more
so if visual acuity is still normal.

31) D
- Complaints of a sudden burst of black spots or floaters indicates that bleeding has occurred as a result of
the detachment. Options A, B, and C are not signs of bleeding.
32) B
- A hyphema is the presence of blood in the anterior chamber. Hyphema is produced when a force is
sufficient to break the integrity of the blood vessels in the eye and can be caused by direct injury, such as a
penetrating injury from a BB or pellet, or indirectly, such as from striking the forehead on a steering wheel
during an accident. The client is treated by bed rest in a semi-Fowler’s position to assist gravity in keeping
the hyphema away from the optical center of the cornea.
33) B
- Treatment for a contusion begins at the time of injury. Ice is applied immediately. The client then should be
seen by a physician and receive a thorough eye examination to rule out the presence of other eye injuries.
34) B
- If the laceration is the result of a penetrating injury, an object may be noted protruding from the eye. This
object must never be removed except by the ophthalmologist because it may be holding ocular structures in
place. Application of an eye patch or irrigation of the eye may disrupt the foreign body and cause further
tearing of the cornea.
35) D
- Emergency care following a chemical burn to the eye includes irrigating the eye immediately with sterile
normal saline or ocular irrigating solution. In the emergency department, the irrigation should be maintained
for at least 10 minutes. Following this emergency treatment, visual acuity is assessed. Options B and C are
not a component of initial care.

36) A
- If the nurse notes the presence of bright red drainage on the dressing, it must be reported to the physician,
because this indicates hemorrhage. Options B, C, and D are inappropriate.
37) B
- In this type of accident, the client is instructed to irrigate the eyes immediately with running water for at
least 20minutes or until the emergency medical service personnel arrive. In the emergency department, the
cleansing agent of choice is normal saline. Calling the physician and going to the emergency room delays
necessary intervention.Hydrogen peroxide is never placed in the eyes.
38) A
- Visual acuity is assessed in one eye at a time, and then in both eyes together, with the client comfortably
standing or sitting. The right eye is tested with the left eye covered; then the left eye is tested with the right
eye covered. Both eyes are then tested together. Visual acuity is measured with or without corrective lenses
and the client stands at a distance of 20 feet from the chart.
39) D
- Vision that is 20/20 is normal—that is, the client is able to read from 20 feet what a person with normal
vision can read from 20 feet. A client with a visual acuity of 20/60 can only read at a distance of 20 feet what
a person with normal vision can read at 60 feet.
40) D
- Legal blindness is defined as 20/200 or less with corrected vision (glasses or contact lenses) or visual acuity
of less than 20 degrees of the visual field in the better eye.

41) B
- Tonometry is the method of measuring intraocular fluid pressure using a calibrated instrument that indents
or flattens the corneal apex. Pressures between 10 and 21 mm Hg are considered within the normal range.
42) A, C, E, F
- Following eye surgery, some scratchiness and mild eye discomfort may occur in the operative eye and
usually is relieved by mild analgesics. If the eye pain becomes severe, the client should notify the surgeon
because this may indicate hemorrhage, infection, or increased intraocular pressure. The nurse also would
instruct the client to notify the surgeon of increased purulent drainage, increased redness, or any decrease
in visual acuity. The client is instructed to place an eye shield over the operative eye at bedtime to protect
the eye from injury during sleep and to avoid activities that increase intraocular pressure, such as bending
over.
43) A
- When an eye drop and an eye ointment are scheduled to be administered at the same time, the eye drop
isadministered first. Options B, C, and D are incorrect.
44) B
- Options A, C, and D are miotic agents used to treat glaucoma. Option B is a mydriatic and cycloplegic
medication, and its use is contraindicated in clients with glaucoma. Mydriatic medications dilate the pupil
and can cause an increase in intraocular pressure in the eye.
45) C
- Miotics cause pupillary constriction and are used to treat glaucoma. They lower the intraocular pressure,
thereby increasing blood flow to the retina and decreasing retinal damage and loss of vision. Miotics cause a
contraction of the ciliary muscle and a widening of the trabecular meshwork. Options A, B, and D are
incorrect.

46) A
- Systemic absorption of pilocarpine hydrochloride can produce toxicity and includes manifestations of
vertigo, bradycardia, tremors, hypotension, syncope, cardiac dysrhythmias, and seizures. Atropine
sulfate must be available in the event of systemic toxicity. Pindolol is a β blocker. Naloxone hydrochloride is
an opioid antagonist used to reverse narcotic-induced respiratory depression. Protamine sulfate is the
antidote for heparin.
47) B
- Hypotension, dizziness, nausea, diaphoresis, headache, fatigue, constipation, and diarrhea are systemic
effects of the medication. Nursing interventions include monitoring the blood pressure for hypotension and
assessing the pulse for strength, weakness, irregular rate, and bradycardia. Options A, C, and D are not
specifically associated with this medication.
48) B
- Cyclopentolate is a rapidly acting mydriatic and cycloplegic medication. Cyclopentolate is effective in 25 to
75minutes, and accommodation returns in 6 to 24 hours. Cyclopentolate is used for preoperative mydriasis.
49) A
- The client can lie down or sit with the head tilted back. The lower lid should be pulled downward with the
thumb or fingers. The client holds the bottle like a pencil, with the tip downward, and squeezes the bottle
gently, allowing one drop to fall into the sac. The client gently closes the eye. Options B, C, and D identify
correct methods for administering eye drops.
50) D
- Applying pressure on the nasolacrimal duct prevents systemic absorption of the medication. Options A, B,
and C will not prevent systemic absorption.